Monday, 24 November 2008
The incurable client
There is another excellent post over at Myalterego (See Myalterego link in my Blogs I like list) titled, “Why I don’t fire the shrink, and follow up”. In it she asks the question about why she does not fire her current shrink and find a new one. This is an interesting question.
I regularly ask my clients if they are getting what they want from the therapy, why are they still coming here, and so forth? I am asking them if they want to continue therapy at all, which is different from Myalterego’s question. She is asking - I want to continue treatment but do I change shrinks?. A different question and one which I am sure I will steal from her and use it myself with clients in the near future.
Anyway she comes up with an interesting list of 8 reasons why she wont change therapists at this point. She essentially comes up with a list of some of the therapist’s characteristics and some qualities of their therapeutic relationship. I would in fact add a number 9 reason.
Question: One reason why am reluctant to change therapists
Answer: Because I have developed a psychological attachment to the current one.
As readers of this blog would know, I am often banging on about how one must never underestimate the power of human attachment. It is a very powerful motivator of human behaviour to maintain a proximity to the attachment figure.
Maintaining proximity
Also raised is the question of when does a client give up looking for a therapeutic solution to ones troubles such as anxiety and depression. When does one accept that this is as good as it is going to get at this point at least. To learn to live with one’s depression or anxiety rather than trying to find a therapeutic solution to decrease it. To accept that there is no hope for any further cure to ones neurosis.
In considering these questions raised by Myalterego I realised that in all my years of training as a psychologist and all my subsequent training in various psychotherapies I have never received any training on such a point. Indeed I can never recall a time when such a thing was even discussed. So like I usually do I will have my say on such a topic.
Perhaps one reason why it is never or rarely discussed is because of the way psychological theories are structured. In most if not every psychological theory there is always a solution defined. There is always a theoretical therapeutic solution to depression or anxiety. Hence forth if there is always at least theoretically a solution then there is no need to consider how to work with a client who has no hope of getting less anxious or less depressed.
Very simplistically
In psychoanalysis one cures anxiety by making unconscious material conscious.
In transference based therapies one cures depression by the client forming an attachment to the therapist that is secure and healthy.
In transactional analysis one cures anxiety by getting the Child ego state to make a redecision.
And so on endlessly.
All clients have choices, don't they?
If these are done and the client is still anxious or depressed then the theories will also have an explanation for that. Either the therapist is not doing the treatment right, or it is simply going to take more time, or the client is blamed as being resistant and so forth.
I am not aware of any psychological theory that says sometimes clients are ‘incurable’ and the gaol is for them to accept their disability and live the fullest life they can with the disability. Perhaps these need to be included in the such theories. Once done, then one is in a position to work with the client from that theoretical basis.
One down side of such an ‘incurable’ concept being included in psychological theories is the self fulfilling prophecy and the highly suggestible client. If a therapist starts to question if the client will ever be anxiety free then the suggestible client can quickly take that on when in fact there may still be considerable hope left.
Another problem is at what point does one accept that treatment is no longer going to be any use? When does a person begin to accept that this is as good as it gets?
What are the answer to such questions I am not sure, yet.
Graffiti
19:26 Permalink | Comments (36) | Email this
Comments
I know this sounds like a silly question however "why do some clients have to be cured or have to accept that this is as good as it gets"?
Perhaps theories and techniques pathologise some clients. Breaking the bonds is as powerful as the attachment that the therapist claims to use?
kenoath
Posted by: kenoath | Monday, 24 November 2008
I agree with you indeed kenoath that our theories pathologise clients.
But I am not too sure what your question is
Cheers
Graffiti
Posted by: Graffiti | Monday, 24 November 2008
One of the things I like about reading your posts Tony, is noting my own reactions. Specifically I notice in my internal thoughts how much I have changed in some ways over the last few years.
I agree, acceptance seems to be important. I am not sure whether it is acceptance of "is this as good as it gets" or is it acceptance of "this is whom I am"; This 'neurosis' is part of my make up.
In fact, if someone accepts it, or indeeds befriends it, maybe then things will get better somewhat anyway? A lessening of an internal battle?
Posted by: Kahless | Tuesday, 25 November 2008
I would think of myself as incurable.
Psychotherapy sounds pretty useless for me personally.
Shruti
Posted by: Shruti | Tuesday, 25 November 2008
Hello Kahless,
I would see them as the same thing.
This is as good as it gets
&
accepting me as I am now
Also I agree that by its very nature psychotherapy sets up an internal battle between two parts of the self in the client and that is detrimental to its stated goals.
Tony
Posted by: Tony | Tuesday, 25 November 2008
And a good morning to you to Shruti,
As to the usefulness of psychotherapy for you I am not sure.
I don't know if you have ever had some psychotherapy but it would seem reasonable to have a go before writing it off, if that is indeed your situation my good friend.
Graffiti
Posted by: Graffiti | Tuesday, 25 November 2008
Why is learning to live with a disability considered a state of being incurable?
Are you suggesting, Tony, that a disability is an illness?
Posted by: roses | Tuesday, 25 November 2008
Tony,
I didnt see them as exactly the same, but rather a path...
struggling to 'improve',
to resignedly saying...
This is as good as it gets
leading to
accepting me as I am now
leading to an 'improvement'
(ie that wasnt as good as it got!)
Am I making sense? Its getting late and I should to to sleep.
Posted by: Kahless | Tuesday, 25 November 2008
its not late Kahless,
It is a bright and beautiful morning.
yes you are making sense and that is a good distinction you make.
Tony
Posted by: Tony | Tuesday, 25 November 2008
Good point Roses,
and another good distincton.
perhaps one is only incurable if they are seeking a cure?.
If one accepts there is no cure and accepts their disability then you could say they are not incurable. As cure is no longer addressed or part of the discussion.
Tony
Posted by: Tony | Tuesday, 25 November 2008
Who says the client needs to be cured anyway? It is their choice or disability that defines whether cure happens or not. There are many alternatives in the counselling process as you point out Grafitti but in doing so, I can see some are already implying there is no hope left for them. That is a sad day indeed when there is no hope left. By accepting that one has a difficult character problem can be tied up in the rebellion to not accept that one is "less than".
Accepting ones state of psychological being can mean reinforcing the original "less than" belief for some people. It seems only natural to defend against that perceived put down and to continue the fight. Sometimes therapy takes a very long time indeed. Others hide their circular neuroses very well indeed, they look normal but are they?
In my view being open and aware of where one is stuck in life is a very thing. Its up to the person whether they wish to stay that way or eventually learn to love their ability to function instead of fighting that.
kenoath
Posted by: kenoath | Tuesday, 25 November 2008
I am all in favor of that Kenoath,
That the client decides if they need to be cured of something or not. I would certainly see it as their choice.
That is a good point Kenoath that the emotional response to no hope is sadness.
I have yet to meet what I would call a 'cured' psychotherapist, so if a psychotherapist feels above a person who asks for cure then perhaps they should look in their own backyard first
Graffiti
Posted by: Tony | Tuesday, 25 November 2008
Haaaaaaaa thank you for pointing out the #9 that I was obviously unaware of! It made me laugh out loud to see that you were so right, and I had totally missed it.
And here's a question - is an unhealthy attachment worth keeping if it is at least an attachment? Is it better than none? I think there are some definite unhealthy things going on between us, and it's not all me.
And I'm more upset about the failure to fix my medications than the therapy stuff. I probably wouldn't look for therapy elsewhere - I'm pretty ambivalent about it even with him. I just want my mood stabilized. I've got my shit like everyone else, but I don't really think I need therapy. And at the moment, it is costing ~1/4 of my salary.
The question - to quit him and get a med second opinion? If I were to seek other therapy, it would definitely be with an LCSW or something, very cognitive based.
Posted by: s | Wednesday, 26 November 2008
S,
You could get a second opinion without telling the current therapist, if that is what you want? And if you cant see the two concurrently cos of the cost, say you just need a vacation to the first one?
Keeps your options open.
Alternatively you could share your posts and comments with the current one?
Posted by: Kahless | Wednesday, 26 November 2008
Hi there G., just talked to Gezunda earlier - it was flippin' great to hear her voice for real. She's talking about coming over to see me in January.
Look, I'm getting itchy feet blogging wise. I'm searching for a new blogging network. Is there any 'market' for silliness in these here parts? If so, I might be tempted to up sticks and re-locate. Blogstream is, well... Blogstream, and Blogger is too quiet - no-one comments. Any advise gratefully accepted.
PS I'm forever blowin' bubbles...
Posted by: Colin Howey | Wednesday, 26 November 2008
Colin,
watch out for gezunda's wellies...
they're wicked
lol!
Posted by: Kahless | Wednesday, 26 November 2008
Hi Sara,
If a person had no attachments at all then it is not long before they would psychologically deteriorate quite quickly.
So if a person only had one attachment then a bad one would be better than none I suppose. But of course the best solution would be to develop some kind of good attachment and that may involved changing the attachment figure.
I was also interested in your other comment. Of course I know very little about you so I can only comment in a generic way.
If someone came to see me and said they had some kind of mood disorder and then stated that they wanted a very cognitive based therapy approach, then the detector in my therapist head would start ringing.
Graffiti
Posted by: Tony | Wednesday, 26 November 2008
Hi, Kahless. I don't think that accepting that something is the way it is means that it will resolve because a person has done that. I still cannot sleep until the morning and I stopped trying to fix it quite a while ago. So it wasn't the worry of having weird sleeping hours that was causing the problem or making it worse. I have simply accepted that I don't go to sleep until morning. Accepting it did not change it at all.
Posted by: Lynn | Wednesday, 26 November 2008
Hi Lynn,
I deliberately in my prior comment didn't use such words like 'cure' or 'resolve'. Because I agree with your comment.
My point was an improvment in say, the internal battle. And I recognise that improvement could be a smidgen. Like you said above have you stopped worrying about the lack of sleep. That is the kind of improvement I was talking about. That is a better place is it not, to be in?
I totally agree that acceptance doesn't make something go away.
Posted by: kahless | Wednesday, 26 November 2008
Why? I want a cognitive based thing maybe for anger management. And for the moods - meds. That's about it. He's the one who is so big on therapy for everything.
And my preference for a cognitive based therapy is a personal opinion type thing that transference based therapy and psychodynamic therapy is kind of bullshit. A non-predictive science...may as well go to religion for that - more promises :) At least I can understand the ideas behind behaviorism and cognition/thoughts.
Posted by: s | Thursday, 27 November 2008
Hi Sara,
If I am listening to someone and my crap detector starts ringing then it starts ringing. Not much I can do about that. Weather I mention it or not is another matter.
If someone reports problem emotions and they want to do CBT then that's Ok with me. I am all for thinking about feelings which is the CBT approach.
I will also say that there is the catharsis approach where people can learn to feel their feelings in non problematic ways. If the person says they do not want to do that because it is based on non predictive science or any other reason then so be it. I accept their decision.
But it is incumbent on me to at least inform them of other approaches and then accept their decision about that.
As for science psychology and psychiatry?. Holley molley that is my soap box for sure. That will be another post I would imagine.
All the best
Graffiti
Posted by: Graffiti | Thursday, 27 November 2008
"If one accepts there is no cure and accepts their disability then you could say they are not incurable. As cure is no longer addressed or part of the discussion."
That statements seems a bit silly to me. What it says is - if we don't say the words then the thought, attitude (looking for a word)... ideal (?perhaps) doesn't exist? It's almost a racist remark but it's not much to do with race - 'much' mind you.
The very fact that they're right there in your room is because they have been trained to believe that if they're a bit different then they have a disability or problem - illness - and they want/need to get it fixed.
Culture's like that isn't it? I guess it had to happen eventually. I've always belived that our immigrants should learn English, understand our laws/culture and appreciate our country. As with most things that doesn't seem to ask too much if they're willing to let go of their past relationship/country/culture does it?
But it is. It's huge. And something's gotta give somewhere if we expect that of people.
It appears that they're damed if they do and damed if they don't. There is always hope when something may be found to be as good as it gets - i like the flavour blends. I like individuality too. I like personal culture and how we mix and match it up just in everyday transactions.
Posted by: roses | Thursday, 27 November 2008
Kahless, I don't usually worry much about it, but this sleeping pattern is a significant inconvenience. Though it is a bit better not to stress out about it so much, living this way creates problems for me. Sometimes when I really think about it - that this is just the way it is - I get very, very angry.
You know what is ironic? It seems like I have stopped worrying about this even though in all practicality, it really IS something that most people would think SHOULD be something to worry about and fix. Similarly, there is no way to fix the fear of doctors and the terrible and lasting meltdown it creates to visit one. I don't worry about that, either. I've simply accepted that I will not have medical care. I wonder where 'acceptance' stops. I guess it's a good thing I'm not a drug addict. Then I might have had to just 'accept' that I need to use drugs. It seems there is a line somewhere between accepting things and just giving up. I think that would make a nice blog topic for Tony.
Posted by: Lynn | Thursday, 27 November 2008
Lynn,
If you don't sleep till morning, what do you do all night?
I'm curious because i tend to do nights particularly well. I sleep well at night also - when that's what we're doing but,
what do you do til morning? You don't ly there and try to sleep till the sun comes up do you? I'm curious.
Posted by: roses | Thursday, 27 November 2008
Hi, Roses. When I do try to 'fix' it, then yes, sometimes I do lie there till morning. Or worse, I might fall asleep for a little while and then wake up, sometimes from a nightmare, and sometimes for no apparent reason. Then I will be unable to go back to sleep until the usual time or even later. Sometimes, though rarely, I will take half of an over-the-counter (non-prescription) sleeping pill. More often I will take NyQuil (non-prescription cold medicine). If I do this, I can go to bed at 5am or so instead of 6 or 7. When I am having problems with anxiety, it can be even later before it feels okay to go to bed. The weird thing is, I have tried taking those remedies EARLY so I can go to bed at a normal time. They do NOTHING for me when I do that. The same things happen when I go to bed too early whether I take anything or not.
I have found it just makes more sense all the way around to just live at night. I do the things that most people do during the day. I clean my house, I research stocks, I shower and care for myself, I hang out on the internet, make my shopping lists, read my mail, pay my bills; I never have a shortage of things to do. If I don't do these things at night, then they do not get done. It is a waste of time to go to bed early and lie in bed for 12 hours when I will only be sleeping for the last 6 to 8 of them. I need those non-sleeping hours for other things. I don't want to lie in bed unless it is to sleep. Otherwise, I would waste my whole life trying in vain to change my sleep. The only way to 'fix' it would be to poison myself and damage my brain with large doses of powerful psychotropic drugs. I am not willing to abuse myself in that way. I have no 'chemical imbalance' that needs correcting. I'm healthy and would like to remain so. I guess I've just decided that this is the way things are. I'm not saying they won't ever change, because I don't know that as I can't know the future.
Thanks for caring to ask after me, Roses.
Posted by: Lynn | Thursday, 27 November 2008
So Lynn,
You sleep ok in the morning - about 6 - 8 hours?
Cause i don't see what's wrong with that. Well, probably because it's happening to you and not to me so i haven't experienced it to understand fully how annoying it is or not.
Does it bother you that you live night life better?
Also - do you have bad dreams while you sleep in the morning/day the same as when you attempt to sleep at night time?
I'm so glad you aren't taking those terrible drugs. I know a man - a person who is very close to us - he has had back surgery and since then has been on pain killing drugs like morphine (i don't know how to spell it) and anti depressent things, sleeping things, anti psychotic stuff. All because of chronic pain. It's starting to eat him from the inside out. I'm glad you don't do that to yourself Lynn - as tough as it may be for you - your insides are staying inside of you atleast.
It's all we can do - is be here for them - regardless of the anger, frustration, tears, humiliation and shame he obviously feels when we meet with them. I love them so much. It hurts. But we love them so that's that.
Posted by: roses | Thursday, 27 November 2008
Lynn,
Do not misinterpret my comments in believing that I have blanket views on acceptance. I dont.
Some things are unacceptable.
Some things are unforgivable.
I am no way a preacher that people should just 'accept' things.
I was making a different point earlier. Probably didnt make it very well.
Conincidentally I was musing yesterday too between acceptance and giving up. Im was thinking specifically about something in me, and wondered had I accepted it, or was it just did I really give a fuck anymore.
I did not reach a conclusion.
Posted by: Kahless | Thursday, 27 November 2008
Kahless, I didn't take your comments that way, my friend. It's just that I have been wondering a lot about it, too, so I dumped the contents of my brain in Tony's comments when the subject came up over here. I thought your point was well made, and it inspired me to blab. :-) I don't have conclusions about all of it, either. Plus, I don't think acceptance implies forgiveness. I think someone can accept that a situation exists, and still not pardon its cause.
Hi, Roses. I suppose the sleep situation might not sound so drastic, but it is very inconvenient when there is business that needs to be handled in the morning hours. No, the same problems do not happen as much when I sleep in the morning. They can still happen, especially the nightmares, but not as bad, and not nearly as often. The only exception seems to be with napping. If I take a nap, there is a very good chance that I will have a nightmare or a night terror. I'm sorry for your friend's troubles, Roses. It is tragic, but it is a very common scenario.
Posted by: Lynn | Friday, 28 November 2008
I agree with you Lynn with what you say about acceptance and forgiveness. I don't think I'm at the acceptance stage yet and I certainly don't forgive. I think some things are just not forgivable. In my Uni class this year we had a person who was so black and white about her views and particularly forgiveness. To her the only way someone can move on is forgiveness and she won't accept anything else. I could feel myself becoming very defensive with her because it was almost like it was reflecting badly on me because I won't forgive. But in the end I decided that I was entitled to the way I felt, regardless of what someone elses view was. I hope I can reach a stage of acceptance because I think within myself I'll have more peace. And that's what is important is to be at peace with myself.
Posted by: KazzaB | Friday, 28 November 2008
You are quite right, Kazza. It is very possible to accept a situation without forgiveness. Acceptance and forgiveness are two very different things. I don't know about you, but it sends up a red flag for me when someone is very insistent about forgiveness. I smell major issues on people who are like that. They seem incredibly vested in that opinion. It doesn't get me fired up and defensive the way it used to when I encounter these opinions, though. They are simply opinions. I have my own about the topic and have become mostly disinterested when I encounter e person such as the one you have described. Though I do hope this person is not going to counsel individuals. I'm not sure someone who is that vested in a specific agenda should be working with people in such a personal arena. The same feelings you experienced with her would also happen to her clients. While it is good that you realised you are entitled to your feelings, can you imagine a person in crisis having their therapist demand that they forgive? She would thus be telling them that they are harming themselves by putting their own true feelings ahead of the comfort of their abusers and some of the more toxic views of society at large. This is extremely damaging and can destroy any progress a person has made in developing proper boundaries and self-care attitudes. These kinds of therapists would probably be better off in working out their own issues before harming the public with them. These are some of the therapists Kahless and I are talking about when we refer to them as arsonists in the fire brigade. They do not bring healing, they bring destruction, confusion, and self-lies.
Posted by: Lynn | Friday, 28 November 2008
One more thing I wanted to say, Kazza. There are many different pieces to each person's puzzle. There are some things I have accepted, and then there are other things that are a bit more difficult. I don't think accepting any situation necessarily comes automatically just because it is 'supposed' to. It is not as simple as some people would like to believe. There is no magic acceptance wand. How about you just accept that there are some things you have not yet accepted?
:-)
I guess that is what I am doing at the moment. Everyone has their own ways and timing. Maybe that is the major thing to be accepted in advance of certain processes.
Posted by: Lynn | Friday, 28 November 2008
I do agree with you about this person Lynn and I think our third year will be very telling for her. My lecturer for this particular group asked for feedback and when I gave it to her, particularly about this persons view what she said was very reasurring. But I do agree that this sort of strong view, if pushed onto the client can do a lot of harm. Hopefully she will take on board that personal views are just that - they should never be pushed onto the client.
I agree acceptance isn't easy and there are some things which I'll have to accept that I'm not at the stage of accepting. :-) If that makes sense at all!! Everyone has a different way of processing things and for some it may be a quick process, for others it takes time. For me it is going to take time. And that's okay.
Posted by: KazzaB | Friday, 28 November 2008
Sadly, unless this future therapists has made conscious what is behind her demand to forgive, she will likely not be able to avoid pushing it onto her traumatised clients. This is the nature of human beings. We cannot control the unconscious. This is why I believe it is so important for therapists to clean up their own messes first lest they inflict themselves on others. You, on the other hand, will make a fine and respectful therapist as you are doing your own work with honesty, patience, and intelligence. It is nice that you have the mercy to not demand some false notion of perfection from yourself. I believe this is truly a form of acceptance.
Posted by: Lynn | Friday, 28 November 2008
I like what you Kazza say Lynn, however not all therapists choose to do their own work. There is a never ending supply of acceptance scenarios in life it seems. Perhaps the therapy is about knowing ones individual process of doing that acceptance or not. When the next wave of integrating some aspect of life into personality comes along one can be more well equipped to tackle that.
I know my dear mother has had a great deal of difficulty accepting getting old in the last twenty years. Some take change quite hard really. The question might be "what is one prepared to do" in their acceptance process.
kenoath
Posted by: kenoath | Friday, 28 November 2008
And I would like to say to the commenters here that there has been some very erudite discussion!!!
Graffiti
Posted by: Tony | Friday, 28 November 2008
Hi, Kenoath!
I can understand a woman (or a man) having some difficulty with getting old. I try to consider the alternative. I prefer getting old to an early death. Can some wrinkles really be so bad? Probably not. I'm sure poor health would be a more difficult issue to accept or deal with (at least for me). I hope your mother is well. I hope you are fine also, Ken.
Posted by: Lynn | Friday, 28 November 2008
Post a comment